Tip/Trick 1

Abstract

OBJECTIVES: To determine the effect of self-directed skill practice with weekly verbal feedback sessions for learning basic open and laparoscopic surgical skills in first year Obstetrics and Gynecology (OBGYN) residents. MATERIALS AND METHODS: First year OBGYN residents entering in July 2009 received a study guide consisting of five learning modules: instrument identification, suturing, knot tying, basic laparoscopic skills, and advanced laparoscopic skills. Each module contained 1) a learning map with prerequisite knowledge and skills, unit contents, and criterion-referenced learning objectives that trainees were expected to meet by the end of the training period, and 2) principles of technique, common errors, and prevention strategies. Each resident was given a take-home skills training box that included: suturing and knot tying boards, a portable laparoscopy training box, and videos. In addition to home training, residents attended 4 weekly practice sessions for 60 min/session. Assessments occurred at baseline and 6 weeks after starting the curriculum in knowledge of surgical instruments and skill performing open suturing, knot tying, and Fundamentals of Laparoscopic Surgery (FLS) tasks including peg transfer, cutting, intracorporeal, and extracorporeal knot tying. These tasks are mandatory skills for graduating general surgery residents. The primary outcome was resident performance using global rating scale (GRS) scores and FLS expert-derived cutoff time criteria. RESULTS: All 7 first year residents participated. Median non-supervised practice time was 125 (98–158) minutes per week. Basic instrument identification improved from 6 (18%) to 29 (85%) instruments (P < .001). Residents' performance significantly improved from baseline to posttest in 10/13 skills including: simple interrupted [GRS score = 1 (0–1) to 4 (2–4) P < .01] simple running [1 (1–2) to 3 (1–4) P < .03], and simple subcuticular suture [1 (0–2) to 3 (2–4) P < .03]; instrument handling while suturing [1 (0–2) to 3 (3–4) P < .03]; one-handed square knot at depth [0 (0–2) to 3 (0–4) P < .03]; laparoscopic peg transfer [192s (±52) to 70s (±40) P = .003]; cutting [233s (±64) to 103s (±25) P = .006]; intracorporeal suturing [300s to 166s (±70) P = .005] and extracorporeal suturing [300s to 153s (±46) P < .001]. All residents reached competence cutoff scores in suturing and instrument handling while 71% reached competence in knot tying and efficiency of movement. Two first year residents were able to successfully perform laparoscopic peg transfer and intracorporeal suturing within cutoff times while 3 were able to successfully perform laparoscopic cutting and extracorporeal suturing within cutoff times. On average, trainees reported being 60% (50–100) better than before they started the curriculum. The majority (86%) of residents reported they would recommend continuing the curriculum for learning surgical skills in their residency, while 7/7 (100%) recommended this curriculum to future incoming first year residents. CONCLUSION: Self-directed skill practice with weekly feedback sessions improves formal basic and advanced surgical skill learning in first year residents.